{"ops":[{"insert":"A 22-year-old woman is referred for further evaluation of a fractured left femur. The fracture occurred yesterday, after she slipped and fell on a flat floor. X-rays revealed a transverse subtrochanteric fracture, with markedly dense cortical boundaries and a reduced intramedullary diameter.\n\nHer medical and surgical histories are unremarkable. She is not on any medications. She does not smoke and only drinks socially. Her mother experienced a Colles fracture at 32 years of age and a fracture of the first metatarsal bone of her right foot at 44 years of age. Her family history is otherwise unremarkable.\n\nA complete blood count is significant for a Hb of 10.5 g\/dL (normal: 12-18), with normal MCV, MCH, and MCHC values. Peripheral smears confirm normochromic normocytic anemia. A reticulocyte count is 0.5% (normal: 0.5-1.5). ESR, CRP, blood urea, serum creatinine, ALT, AST, alkaline phosphatase (ALP), INR, and serum bilirubin are all within normal parameters.\n\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-S-086_en.png"}},{"insert":"\n"}]}
2
Investigate
Serum TSH and PTH
{"ops":[{"insert":"Serum thyroid stimulating hormone (TSH) and parathyroid hormone (PTH) levels are within normal parameters.\n"}]}
Skeletal survey
{"ops":[{"insert":"Skull","attributes":{"bold":true}},{"insert":": thickening of the inner and outer cortical tables, with increased radiodensity at the skull base."},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"Spine","attributes":{"bold":true}},{"insert":": increased radiodensity of all vertebrae, with sclerotic bands over the endplates (i.e. \u0022sandwiched vertebrae\u0022 appearance)."},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"Pelvis","attributes":{"bold":true}},{"insert":": expanding osteosclerosis of the pelvic bones, with a \u0022bone within a bone\u0022 appearance."},{"insert":"\n","attributes":{"list":"bullet"}}]}
